Today's Veterinary Practice

MAY-JUN 2014

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| PracTical DenTisTry Today's Veterinary Practice May/June 2014 100 tvpjournal.com ple, another possible, but unlikely cause, is tetracycline use in very young patients; most, if not all teeth, become discolored (yellow/brown). Intrinsic staining results when ex- travasated blood is forced into the den- tinal tubules and then degenerates: 1. A tooth stained by degenerating blood products following pulp hem- orrhage appears pink immediately after the injury, eventually becoming darker brown or gray (Figure 10). 2. Although dental pulp can heal after injury, the vast majority of discol- ored teeth are nonvital. 3. Once the tooth becomes nonvital, it often becomes infected via the blood supply, in a process known as anachoresis. 4. Once the tooth becomes infected, it acts as a bacterial fortress, allowing bacteria to create periapical infec- tion, which may spread to the entire body. 5. Intrinsically stained teeth can also cause clinical abscessation. The only exceptions to the above process are: • Young patients: The large end- odontic system and good blood supply of these patients allow them to recover from the inflammatory pulpitis, and the tooth returns to normal color in a few weeks. If this does not occur, the tooth should be considered nonvital. • Patients with only discolored cusps (rest of the tooth unaffected) (Figure 11): These teeth should be radiographed and transilluminated; if both results are normal, the tooth should be monitored. Clinical Signs & Diagnosis Clinical observation is generally diag- nostic. Transillumination should be per- formed if there is any question wheth- er the tooth is discolored (Figure 12). Note: As pulp cavity diameter decreas- es with age, transillumination becomes less reliable and eventually impossible. Dental radiographs should also be exposed to determine the condition of the roots. • Nonvitality is indicated by change in width of the endodontic space or periapical lucency (Figure 13). • Pulp necrosis is indicated by a larger root canal diameter than the contralateral tooth. • Generalized pulpitis is indicated by a smaller diameter root canal space than the contralateral tooth. • Periapical lucency is evidence of endodontic infection, causing bony resorption. Normal radiographs do not indi- cate that the tooth is alive and not in- fected, but some will argue that lack of radiographic changes indicates the Figure 10. Discolored (intrinsically stained) teeth—(A) left mandibular canine (304), (B) right maxillary canine (104), (C) left maxillary first incisor (201), and (D) left maxillary fourth premolar (208). A B C D Figure 13. Dental radiograph of intrinsically stained left maxillary canine (204); this tooth is obviously nonvital and infected, as evidenced by the widened endodontic system (blue arrows) and periapical rarefac- tion (red arrows). A B Figure 11. Intrinsic staining of cusp tip of left mandibular canine (304). Figure 12. Transillumination—(A) normal transillumination of right max- illary canine (104) (note that the light passes through fairly well), and (B) transillumination of the contralateral tooth (note the light attenuation from intrinsically stained dentin). TVP_2014_0506_PD_HardTissue-Periodontal.indd 100 5/23/2014 6:35:55 PM

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